Centennial Care Restructuring the State s Medicaid Program Summary and DRNM Comments on New Mexico s Revised 1115 Waiver Application September 6, 2012
|
|
- Harvey Gibson
- 6 years ago
- Views:
Transcription
1 Centennial Care Restructuring the State s Medicaid Program Summary and DRNM Comments on New Mexico s Revised 1115 Waiver Application September 6, 2012 Overview New Mexico is once again asking for federal approval of a plan that would significantly change the state s Medicaid service delivery system. The proposal is in the form of an application for a waiver under Section 1115 of the Social Security Act. These "1115" waivers are intended to demonstrate new and more effective ways to provide health care services to Medicaid participants. The first application by the Human Services Department (HSD), submitted in April, was withdrawn in May since the state had not adequately consulted with Native American tribal officials and service providers. With new federal regulations in place requiring public input, HSD also held public hearings on the original proposal. The revised version reflects some of the comments and suggestions submitted to HSD. The new application was sent in on August 17. CMS, the federal agency in charge of such waivers, will be taking public comments on the state's application for the next 30 days. Comments can be submitted through the following CMS web site: Information/By-Topics/Waivers/1115/public-comments.html. Scroll down the list of states to find New Mexico. The deadline for submitting comments appears to be October 4, The state's plan, Centennial Care, is scheduled to go into effect in January The Human Services Department (HSD), which is the state's Medicaid agency, plans to select up to five MCOs (Managed Care Organizations), each of which would be responsible for providing the full range of Medicaid benefits: physical health, behavioral health, and long term services. The state has just issued a "Request for Proposals" from interested MCOs and those proposals are due on November 20, HSD plans to pick the MCOs it wants by the end of 2012 and use 2013 getting everyone - MCOs, providers and participants - ready for program implementation in Services currently provided through the Developmental Disabilities waiver will not be included in the new program. However, individuals on that waiver will receive their physical health services through the new MCOs selected for Centennial Care. Medicaid-covered therapies and other services offered as part of a special education student's IEP, and Family-Infant-Toddler services, will also be excluded from Centennial Care. The new approach emphasizes care management and care coordination, intended to assure that Medicaid participants promptly get the care they need in order to reduce or avoid hospitalization or other expensive services. This approach includes a pilot project ("behavioral health homes") that would take on responsibility for coordinating all aspects of a person's behavioral health care needs. Another initiative would base provider payments on health outcomes ("pay for performance") rather than simply on the specific services or treatments provided. All Medicaid participants will be
2 expected to take more responsibility for their health care needs, getting small rewards for "doing the right thing" such as having children immunized, and facing penalties in the form of co-pays for unnecessary use of hospital emergency rooms or insisting on brand name drugs when generic versions are available (though this would not apply to psychotropic medications). Centennial Care features a new approach to long term services that promises to provide help to a large number of people who need these services but are on waiting lists, but it limits the cost of community-based services to no more than the cost of nursing home placement. Major Changes to Medicaid Under Centennial Care Τhe new approach combines almost all physical health, behavioral health and long term services for all Medicaid recipients into one integrated program. Instead of having separate managed care programs for physical health ( Salud ), behavioral health (currently provided by Optum Health), and long term services ( CoLTS ), each MCO with a Medicaid contract will be required to cover all these Medicaid services statewide. HSD will probably pick 3 5 MCOs to provide these services. Since there are currently 7 Medicaid MCOs, and since HSD may select new MCOs that don't currently participate in the program, many Medicaid recipients will likely end up in a different MCO than they have now. DRNM is concerned that some MCOs may not have the expertise and capacity needed to provide the full range of Medicaid services state-wide. Consumers will have to try to compare various provider networks to see which ones include their current medical providers, and such information has not been readily available during past Medicaid transitions. Many participants may end up having to change doctors or other providers if one (or more) of their current providers is not in the network of the new MCO they choose or get assigned to, which may cause problems in continuity of care. The Centennial Care proposal does not address the question of whether the state will increase Medicaid eligibility to 138% of the Federal Poverty Level (FPL), as called for under federal health care reform. However, it does makes a few important changes to Medicaid eligibility: It appears that adults will be covered by the Centennial Care Medicaid program at least up to 100% FPL. In the current Medicaid program, parents of minor children are covered only up to around 30% FPL, and childless adults are not covered at all unless they qualify based on disability or some other separate qualifying condition, so Centennial Care would involve a significant expansion of the program. Those whose income is higher than typical Medicaid eligibility levels but currently qualify for Medicaid based on breast or cervical cancer, or who qualify to receive Medicaid-funded family planning services, will qualify in Centennial Care only up to 100% FPL rather than the higher income-eligibility levels that apply now. Fortunately, in response to concerns raised by DRNM and others, there will be no change to eligibility for the Working Disabled Individuals program, which offers Medicaid eligibility for certain individuals with disabilities with income up to 250% FPL. And pregnancy-related services will still be provided for women up to 185% FPL. HSD had earlier proposed capping eligibility for both of these programs at 138% FPL. There will be up to 12 months continuous eligibility for adults. This means that once found eligible based on income, an adult would remain eligible for 12 consecutive months even if there is some fluctuation in the person s income. All Medicaid participants will be screened to determine the extent of their current health care needs, and special emphasis will be placed on care coordination and case management services for those with more intensive needs. This was supposed to be a key element of the CoLTS program, but
3 HSD appears to recognize that CoLTS has fallen short of expectations. DRNM has heard from many CoLTS participants that it is hard to reach their care coordinators and that they seem to receive little benefit from this service. DRNM appreciates the further emphasis on assuring that participants get what they need, but it is not clear how Centennial Care will improve on the CoLTS model and assure the desired outcome. Participants who use a hospital emergency room for a condition that turns out not to be an emergency will have to pay a co-pay if alternative services are available but the person insists on receiving treatment in the ER. The proposed co-pay amounts exceed what's currently allowed by federal law. DRNM notes that there are few if any alternatives to ERs on evenings or weekends and shares the concerns of many advocates and providers that this will be difficult to administer. The state proposes to waive the current requirement that Medicaid cover the cost of medical services provided in the three months before a person applies for Medicaid (if they are found eligible for Medicaid at the time of application and for the preceding months). However, in response to widespread concerns over this request, HSD has agreed to delay implementation of this aspect of Centennial Care for six months, until July DRNM appreciates the brief delay, but this new policy remains problematic. Since many people don't apply (or re-apply) until after they have started to receive necessary medical services, such a waiver would mean that the bill for such earlier services would not be covered by Medicaid and the cost would have to be paid by the low income individual or the health care provider(s) simply wouldn t get paid. The state proposes to require Native American Medicaid recipients to enroll in Centennial Care. Currently, only Native Americans who are in one of the CoLTS population groups (people who are eligible for both Medicaid and Medicare, and those who receive Medicaid long term services) are required to be in this managed care program. Those who are eligible for the general Medicaid Salud program may choose whether to enroll in managed care or remain in the traditional fee for service program, and only about 15-20% of those eligible have chosen to enroll in Salud. Native American tribal governments in New Mexico have been unanimous in opposing the state s plan for mandatory enrollment. Long Term Services The Centennial Care plan would make several major changes to the current system for providing long term services under Medicaid: Α variety of services, including attendant care services (Personal Care Option or PCO) and most of the services that are currently provided only through waiver programs (Disabled and Elderly, Medically Fragile, Mi Via), such as assisted living, skilled maintenance therapy, private duty nursing, respite, etc., will be packaged together as a Community Services Benefit. Everyone who is income-eligible for Medicaid and meets the nursing home level of care will be eligible to access the full range of long term services in the Community Services Benefit without having to be in a waiver slot. This will quickly and substantially expand the number of people who can get these needed services in two ways. People who are currently on the hopelessly long waiting list for waiver services and qualify for Medicaid based on income will get access to community-based services without a slot. And many people already on the waiver can give up their slot without losing eligibility or services, which will free up slots for individuals at slightly higher income levels. This approach to services is consistent with recommendations provided to HSD by DRNM and The Disability Coalition.
4 There will continue to be a waiting list for individuals who are not income-eligible for Medicaid but who have incomes not exceeding 225% FPL and who need long term services. There are around 17,000 people now on the waiting list for Disabled and Elderly waiver services, since virtually no one has come off it in the last few years. HSD's plan promises that a limited number of slots in Centennial Care they haven t said how many will be provided for some of those on the waiting list in the first year, with additional slots allocated on an annual basis in future years. HSD may change the way it prioritizes allocations for slots, giving priority for allocations based on the extent and the urgency of need rather than just first-come first-served based on the length of time someone has been on the list. Under Centennial Care, the cost of community-based services for an individual (the Community Services Benefit) cannot exceed the cost of nursing home services. DRNM believes that this provision discriminates against those with more severe disabilities and eliminates their opportunity for integration into the community, and thus violates the Americans with Disabilities Act. The Mi Via self-directed waiver program comes to an end with Centennial Care, but selfdirection will be available with respect to many (but not all) long term services. It will be available to everyone who receives those services and is capable of self-direction without having to be in a waiver slot as is the case today. The Centennial Care MCOs will be required to provide assistance to those who want to self-direct their long term services, either through their own staff or through contract with agencies providing consultant services. HSD s Community Reintegration program, which allows people to transition from nursing homes to community services by giving them waiver slots when they become available, will apparently continue in Centennial Care. However, unlike current practice, some slots in Centennial Care will also be allocated to persons on the waiting list, as indicated above. Assistance in transitioning from facilities such as nursing homes into the community is one of the services provided as part of the Community Benefit, but this will only be available to those who have been in such a facility for at least 90 days. DRNM finds it ironic that a 90-day nursing home stay is required to receive this benefit, since the primary reason given by HSD for withdrawing from the federally supported Money Follows the Person program was that it was limited to those with at least a 90-day stay. The Community Integration program is controversial in the disability community because it places facility residents ahead of everyone already on the waiting list. This creates a perverse incentive to place a person in a nursing home in order to go through the program to transition back into the community with waiver supports and services services that one would otherwise have to wait years to receive. Behavioral Health Services In the current Medicaid program, behavioral health services for children and adults with significant needs are provided through one state-wide MCO (currently Optum Health) through contract with the state s multi-agency Behavioral Health Purchasing Collaborative. Centennial Care features a carve in approach intended to integrate physical health and behavioral health by making MCOs responsible for providing the full range of Medicaid services that a participant needs, including behavioral health. The goal is a holistic approach that coordinates treatment for medical and behavioral health. However, the new model allows the MCOs to subcontract with partner organizations to coordinate and deliver behavioral health services, and requires the MCOs to delegate much of their behavioral health service delivery to Core Service Agencies. DRNM supports the integrated model for physical and behavioral health, but it is not clear how subcontracting the
5 management of behavioral health and delegating delivery to the CSAs will assure that this integration occurs. In the state s new plan, all Medicaid participants will be screened to assess the scope and intensity of the health care services they need, including behavioral health. Those with moderate or intensive needs will receive services pursuant to an annual plan of care, although the assessment process appears to rely heavily upon self-reporting. This may be a problem because some individuals may be hesitant to report a need for services in an attempt to avoid stigma or unwanted interventions. Most individuals with intensive needs will be referred to a Core Service Agency, which will provide traditional behavioral health services as well as Comprehensive Community Support Services (CCSS) and some care coordination. Some but not all Core Service Agencies will be designated as a "behavioral health home" and will provide a broader and more extensive level of care coordination and case management. Three new behavioral health services will be added to the current Medicaid benefit package: peer to peer recovery services, family support, and respite care for families of youth with mental illness. DRNM welcomes the addition of these services as part of the Centennial Care benefit package. The plan provides an assurance that funding currently earmarked for behavioral health will continue to be dedicated to this purpose, but it is not clear how this will be accomplished. The fact that the plan seems to allow all of the costs of integrating physical and behavioral health to come out of existing behavioral health funding creates some doubt about this assurance.
Native American Frequently Asked Questions
Native American Frequently Asked Questions What is Centennial Care? Centennial Care is the new name of the New Mexico Medicaid program. Centennial Care will begin January 1, 2014 and services will be provided
More informationChildren and Adults Health Programs Group. November 18, 2014
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-01-16 Baltimore, Maryland 21244-1850 Children and Adults Health Programs Group November
More information1115 Waiver Renewal Tribal Consultation June 23, New Mexico Human Services Department
1115 Waiver Renewal Tribal Consultation June 23, 2017 New Mexico Human Services Department 1 Centennial Care 2.0 Concepts Public Comments Wrap Up Provide information about Centennial Care: overview, goals,
More informationWhat are MCOs? (b)/(c) refers to the type of waiver approved by CMS to allow this type of managed care program. The
Advocating in Medicaid Managed Care-Behavioral Health Services What is Medicaid managed care? How does receiving services through managed care affect me or my family member? How do I complain if I disagree
More informationCentennial Care 2.0 Section 1115 Demonstration Waiver Renewal Concept Paper
Centennial Care 2.0 Section 1115 Demonstration Waiver Renewal Concept Paper New Mexico Human Services Department MAY 19, 2017 Table of Contents 1. Executive Summary... 1 2. Centennial Care Overview...
More informationMaryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012
Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint
More informationAlaska Mental Health Trust Authority. Medicaid
Alaska Mental Health Trust Authority Medicaid November 20, 2014 Background Why focus on Medicaid? Trust result desired in working on Medicaid policy issues and in implementing several of our focus area
More informationCOMMUNITY-BASED LONG TERM CARE PROGRAMS IN WISCONSIN. Attorney Mitchell Hagopian Disability Rights Wisconsin July 2013
COMMUNITY-BASED LONG TERM CARE PROGRAMS IN WISCONSIN I. INTRODUCTION Attorney Mitchell Hagopian Disability Rights Wisconsin July 2013 In 1981, with the creation of the Community Options Program, the state
More informationABC's of Managed Care and What It Might Mean for Home & Community Based Services
ABC's of Managed Care and What It Might Mean for Home & Community Based Services This project is supported by a grant from the Pennsylvania Developmental Disabilities Council. David Gates DGates@phlp.org
More informationServing CYSHCN in Medicaid Managed Care: Contract Language and the Contracting Process
Serving CYSHCN in Medicaid Managed Care: Contract Language and the Contracting Process November 16, 2017 1:00-2:00 PM, ET For audio: 888-757-2790 Passcode: 105799 Press *6 to mute/unmute your line. Please
More informationHealth Law PA News. Governor s Proposed Medicaid Budget for FY A Publication of the Pennsylvania Health Law Project.
Health Law PA News A Publication of the Pennsylvania Health Law Project Volume 21, Number 2 Statewide Helpline: 800-274-3258 Website: www.phlp.org In This Issue Community HealthChoices Update Pennsylvania
More informationTransforming Louisiana s Long Term Care Supports and Services System. Initial Program Concept
Transforming Louisiana s Long Term Care Supports and Services System Initial Program Concept August 30, 2013 Transforming Louisiana s Long Term Care Supports and Services System Our Vision Introduction
More informationDiamond State Health Plan Plus
I N T E G R A T E D L O N G T E R M Diamond State Health Plan Plus DSHP-Plus C A R E 1115 Demonstration Waiver Diamond State Health Plan (DSHP) Managed Care Delivery System Operational since January 1996
More informationNEW YORK STATE MEDICAID REDESIGN TEAM AND THE AFFORDABLE CARE ACT (MRT & ACA)
NEW YORK STATE MEDICAID REDESIGN TEAM AND THE AFFORDABLE CARE ACT (MRT & ACA) The Affordable Care Act (ACA) The Affordable Care Act 3 Officially called the Patient Protection and Affordable Care Act (PPACA)
More informationNEW MEXICO DEPARTMENT OF HEALTH DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION MEDICALLY FRAGILE WAIVER (MFW)
NEW MEXICO DEPARTMENT OF HEALTH DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION MEDICALLY FRAGILE WAIVER (MFW) CASE MANAGEMENT Effective January 1, 2011 MFW case management is a collaborative process of assessment,
More informationIllinois Health Care Coverage Options Conference AgeOptions All rights reserved.
Illinois Health Care Coverage Options Conference AgeOptions 2017. All rights reserved. MMW work is supported by grants from local and regional foundations: Retirement Research Foundation Michael Reese
More informationExamples of Measure Selection Criteria From Six Different Programs
Examples of Measure Selection Criteria From Six Different Programs NQF Criteria to Assess Measures for Endorsement 1. Important to measure and report to keep focus on priority areas, where the evidence
More informationFEB DEPARTMENT OF HEALTH & HUMAN SERVICES
DEPARTMENT OF HEALTH & HUMAN SERVICES FEB - 2 2016 Centers for Medicare & Medicaid Services Administrator Washington, DC 20201 Mr. Darin Gordon Director Bureau of Tenn Care Tennessee Department of Finance
More informationOverview of Medicaid Program
Joint HHS Appropriations Subcommittee FY 2017-19 Overview of Medicaid Program Steve Owen, Fiscal Research Division Overview of Medicaid WHAT IS MEDICAID? Medicaid is funded through Title XIX of the Social
More informationFlorida Statewide Medicaid Managed Care: Long-term Care Managed Care Program
Florida Statewide Medicaid Managed Care: Long-term Care Managed Care Program David A. Rogers Assistant Deputy Secretary for Medicaid Health Systems Agency for Health Care Administration Florida Health
More informationMedi-Cal and the Safety Net California Association of Health Plans Seminar Series Medi-Cal at its Core
Medi-Cal and the Safety Net California Association of Health Plans Seminar Series Medi-Cal at its Core August 3, 2017 Deborah Kelch Executive Director Insure the Uninsured Project 1 Safety-Net Definitions
More informationAssignment of Medicare Fee-for-Service Beneficiaries
February 6, 2015 Ms. Marilyn B. Tavenner, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1461-P Room 445-G, Hubert H. Humphrey Building 200
More informationFrom HARPs to DSRIP to VBP: What Do They Mean To You?
From HARPs to DSRIP to VBP: What Do They Mean To You? North Country NYAPRS 2016 Winter Forum Harvey Rosenthal Executive director 1 New York Association of Psychiatric Rehabilitation Services (NYAPRS) A
More informationHeather Leschinsky Administrator II, Managed Care and HCBS Nebraska Department of Health and Human Services Medicaid and Long-Term Care
Heather Leschinsky Administrator II, Managed Care and HCBS Nebraska Department of Health and Human Services Medicaid and Long-Term Care 1 2 Total Medicaid and CHIP population- 235,000 Currently approximately
More informationBenefits. Section D-1
Benefits Section D-1 Practitioners/providers who participate in Medicaid agree to accept the amount paid as payment in full (see 42 CRF 447.15) with the exception of co-payment amounts required in certain
More informationDHS Requires Standardized Outcome Measures and Level of Care Determinations for Children s Mental Health
#09-53-02 Bulletin April 22, 2009 Minnesota Department of Human Services -- P.O. Box 64941 -- St. Paul, MN 55164-0941 OF INTEREST TO County Directors Tribal Directors Social Services Supervisors and Staff
More informationIntroduction for New Mexico Providers. Corporate Provider Network Management
Introduction for New Mexico Providers Corporate Provider Network Management Overview New Mexico snapshot. Who we are. Why Medicaid managed care? Why AmeriHealth Caritas? Why partner with us? Medical Management
More informationDisability Rights California
Disability Rights California California s protection and advocacy system LEGISLATION & PUBLIC INFORMATION UNIT 1831 K Street Sacramento, CA 95811-4114 Tel: (916) 504-5800 TTY: (800) 719-5798 Fax: (916)
More informationFamily and Youth Peer Support September 19, 2011, 2:00 4:00 p.m., ET
Care Management Entity Quality Collaborative Technical Assistance Webinar Series Family and Youth Peer Support September 19, 2011, 2:00 4:00 p.m., ET For audio and to participate, dial: (866) 699-3239
More informationIllinois' Behavioral Health 1115 Waiver Application - Comments
As a non-profit organization experienced in Illinois maternal and child health program and advocacy efforts for over 27 years, EverThrive Illinois works to improve the health of Illinois women, children,
More informationPresented by New Mexico Department of Health Developmental Disabilities Supports Division DDW Renewal Information for Public Comment Period December
Presented by New Mexico Department of Health Developmental Disabilities Supports Division DDW Renewal Information for Public Comment Period December 7, 2016 1 WELCOME 2 State Agencies Role in the DD Waiver
More informationMedicaid for Youth in the Juvenile Justice System A Fact Sheet Prepared by the Youth Law Center
A Fact Sheet Prepared by the Youth Law Center What is Medicaid? Medicaid is a medical assistance program for low income people. The federal government pays a share of the health care costs for eligible
More informationRE: NLADA Comments to Draft 2015 Compliance Supplement (80 Fed. Reg ) (December 4, 2015)
Sent by email to: aramirez@oig.lsc.gov January 14, 2016 Anthony M. Ramirez Office of the Inspector General, Legal Services Corporation 3333 K Street NW Washington, D.C. 20007 RE: NLADA Comments to Draft
More informationApril 17, The Honorable Mac Thornberry Chairman. The Honorable Adam Smith Ranking Member
April 17, 2015 The Honorable Mac Thornberry Chairman The Honorable Adam Smith Ranking Member Armed Services Committee 2126 Rayburn House Office Building Washington, D.C. 20515 Dear Chairman Thornberry
More informationPreliminary. LTHHCP Issues, Concerns and Recommendations For Discussion with NYS Department of Health At HCA Statewide LTHHCP Forum (Updated 3/4/13)
1 Preliminary LTHHCP Issues, Concerns and Recommendations For Discussion with NYS Department of Health At HCA Statewide LTHHCP Forum (Updated 3/4/13) March 7, 2013 Hotel Albany, Albany NY LTHHCP Role,
More informationQuality Strategy For the New Mexico State Medicaid Managed Care Program
Quality Strategy For the New Mexico State Medicaid Managed Care Program Prepared by The New Mexico Human Services Department Medical Assistance Division Quality Bureau October 2013 1 I. INTRODUCTION A.
More informationIowa Medicaid: Innovations & Initiatives
Iowa Medicaid: Innovations & Initiatives ICD-10 ACA Expansion Presumptive Eligibility Health Information Technology PERM DHS Initiatives Adult Quality Measures SIM CDAC Topics 2 ICD-10 3 1 ICD-10 Background
More informationSTAR Kids Update. Medicaid and CHIP Division Texas Health and Human Services Commission. August 2016
STAR Kids Update Medicaid and CHIP Division Texas Health and Human Services Commission August 2016 STAR Kids Background Senate Bill (S.B.) 7, 83rd Legislature, Regular Session, 2013, directs HHSC to establish
More informationFederal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act
October 2018 Issue Brief Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act MaryBeth Musumeci and Jennifer Tolbert On October 3, 2018, the Senate overwhelmingly passed
More informationOpportunities to Advance Lifespan Respite: Managed Long-Term Services and Supports and Affordable Care Act Options
Opportunities to Advance Lifespan Respite: Managed Long-Term Services and Supports and Affordable Care Act Options October 18, 2013 Joe Caldwell Director of Long-Term Services and Supports Policy 1 Overview
More informationMEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN
Louisiana Behavioral Health Partnership MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN Rosanne Mahaney - Delaware Lou Ann Owen - Louisiana Brenda Jackson,
More informationMedicaid Efficiency and Cost-Containment Strategies
Medicaid Efficiency and Cost-Containment Strategies Medicaid provides comprehensive health services to approximately 2 million Ohioans, including low-income children and their parents, as well as frail
More informationFIDA. Care Management for ALL
Care Management for ALL In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state s Medicaid program. This included a critical initiative
More informationMedicaid Managed Care Readiness For Agency Staff --
Medicaid Managed Care Readiness 101 -- For Agency Staff -- To Understand: Learning Objectives Basic principles of Managed Care as a payment vehicle for health care services The structure of the current
More informationLong-Term Care Improvements under the Affordable Care Act (ACA)
Long-Term Care Improvements under the Affordable Care Act (ACA) South Carolina Health Care Implementation Coalition September 17, 2010 JoAnn Lamphere, DrPH Director, State Government Relations Health &
More informationPerformance-Based Contracting
Performance-Based Contracting Presentation to the National Council Shannon Freedle, CEO, TeamBuilders Deb Adler, SVP, National Networks, OptumHealth Behavioral Solutions Pam Martin, VP, Networks, OptumHealth
More informationMedicaid Fundamentals. John O Brien Senior Advisor SAMHSA
Medicaid Fundamentals John O Brien Senior Advisor SAMHSA Medicaid Fundamentals Provides medical benefits to groups of low-income people with no medical insurance or inadequate medical insurance. Federally
More informationFor Profit Managed Care for Long Term Supports & Services Lessons Learned
For Profit Managed Care for Long Term Supports & Services Lessons Learned Mike Chittenden, The Arc Nebraska Kevin Fish, The Arc of Sedgwick County Carrie Hobbs Guiden, The Arc Tennessee John Nash, The
More informationGrievances and Resident/Family Councils
A Closer Look at the Revised Nursing Facility Regulations Grievances and Resident/Family Councils Executive Summary Residents have the right to file grievances and the facility must work to resolve those
More informationMedicaid Home- and Community-Based Waiver Programs
INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Danyell Punelli, Legislative Analyst 651-296-5058 Updated: October 2016 Medicaid Home-
More informationTribal Recommendations to Integrate the Indian Health Care Delivery System Into Oregon s Coordinated Care Organizations (H.B.
Tribal Recommendations to Integrate the Indian Health Care Delivery System Into Oregon s Coordinated Care Organizations (H.B. 3650) January 9, 2012 Executive Summary House Bill 3650 establishes the Oregon
More informationWashington State Indian Health Care Legislation for 2018
Washington State Indian Health Care Legislation for 2018 American Indian Health Commission for Washington State Presented By: Vicki Lowe, AIHC Executive Director AMERICAN INDIAN HEALTH COMMISSION FOR WASHINGTON
More informationTestimony of: NEW YORK STATE HEALTH FACILITIES ASSOCIATION and NEW YORK STATE CENTER FOR ASSISTED LIVING (NYSHFA/NYSCAL) on the
Testimony of: NEW YORK STATE HEALTH FACILITIES ASSOCIATION and NEW YORK STATE CENTER FOR ASSISTED LIVING (NYSHFA/NYSCAL) on the 2016 17 New York State Executive Budget Proposal Health & Mental Hygiene
More informationWV Bureau for Medical Services & Molina Medicaid Solutions
WV Bureau for Medical Services & Molina Medicaid Solutions On January 1, 2014, Medicaid eligibility was expanded to qualified individuals ages 19 to 64 making 138% of the Federal Poverty Level. 112,464
More informationMedicaid Update Special Edition Budget Highlights New York State Budget: Health Reform Highlights
Page 1 of 6 New York State April 2009 Volume 25, Number 4 Medicaid Update Special Edition 2009-10 Budget Highlights David A. Paterson, Governor State of New York Richard F. Daines, M.D. Commissioner New
More informationManaged Long-Term Care in New Jersey
Managed Long-Term Care in New Jersey April 2009 Jon S. Corzine Governor Heather Howard Commissioner Introduction New Jersey s Fiscal Year 2009 Budget included the following language: On or before April
More informationMEDICAID OPTIONAL ELIGIBILITY AND SERVICES: OPTIONS THAT AREN T REALLY OPTIONS
MEDICAID OPTIONAL ELIGIBILITY AND SERVICES: OPTIONS THAT AREN T REALLY OPTIONS Introduction Created in 1965, Medicaid is a federal and state-funded program that most people think of as simply a health
More informationPublic Health Law Series Webinar. Medicaid 1115 Waivers: How are they Transforming the Health System?
Public Health Law Series Webinar Medicaid 1115 Waivers: How are they Transforming the Health System? How to Use Webex Audio: If you can hear us through your computer, you do not need to use your phone.
More informationDisabled & Elderly Health Programs Group. August 9, 2016
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-14-26 Baltimore, Maryland 21244-1850 Disabled & Elderly Health Programs Group August
More information5 TRANSITIONS OF CARE Revision Dates: August 15, 2014, March 1, 2017 Effective Date: January 1, 2014
5 TRANSITIONS OF CARE Revision Dates: August 15, 2014, March 1, 2017 Effective Date: January 1, 2014 In managed care, HSD will continue its commitment to providing the necessary supports to assist members
More informationWEST VIRGINIA S MEDICAID CHANGES UNLIKELY TO REDUCE STATE COSTS OR IMPROVE BENEFICIARIES HEALTH By Judith Solomon
820 First Street NE, Suite 510 Washington, DC 20002 Tel: 202-408-1080 Fax: 202-408-1056 center@cbpp.org www.cbpp.org May 31, 2006 WEST VIRGINIA S MEDICAID CHANGES UNLIKELY TO REDUCE STATE COSTS OR IMPROVE
More informationSMMC: LTC and MMA. Linda R. Chamberlain, P.A. Member Firm Florida Elder Lawyers PLLC
SMMC: LTC and MMA Linda R. Chamberlain, P.A. Member Firm Florida Elder Lawyers PLLC 727.443.7898 Why should you care about SMMC Florida has 7M+ people 50 y/o + 4M+ Social Security beneficiaries 3.5M+ Medicare
More informationVirginia s ID/DD Waiver Re-Design Update
Virginia s ID/DD Waiver Re-Design Update vaaccses Annual Provider Conference June 8, 2015 Connie Cochran, Assistant Commissioner and Dawn Traver, Waiver Operations Director Division of Developmental Services
More informationProtect Medicaid Consumer Protections and Due Process. Kim Lewis, Managing Attorney Wayne Turner, Senior Attorney
Protect Medicaid Consumer Protections and Due Process Kim Lewis, Managing Attorney Wayne Turner, Senior Attorney www.healthlaw.org @NHeLP_org March 24, 2017 2 About NHeLP National non-profit committed
More informationHighlights of Program Integrity Provisions Managed Care Delivery System Subcommittee June 9, 2011
Patient Protection and Affordable Care Act: Highlights of Program Integrity Provisions Managed Care Delivery System Subcommittee June 9, 2011 1 Provider Screening and Other Enrollment Requirements Provider
More informationNC TIDE 2016 Fall Conference November 14, Department of Health and Human Services NC Medicaid Reform Update
NC TIDE 2016 Fall Conference November 14, 2016 Department of Health and Human Services NC Medicaid Reform Update Agenda National Medicaid Landscape Medicaid Transformation in NC 1115 Waiver Process NC
More informationTennessee s Money Follows the Person Demonstration: Supporting Rebalancing in a Managed Long-Term Services and Supports Model
Tennessee s Money Follows the Person Demonstration: Supporting Rebalancing in a Managed Long-Term Services and Supports Model In 2011, Tennessee was awarded a federal Money Follows the Person (MFP) grant,
More informationFrequently Asked Questions About IRIS and Family Care Organizations
Frequently Asked Questions About IRIS and Family Care Organizations Update: July 14, 2017 Differences/similarities between Family Care (FC) and IRIS: Are there any services available in Family Care or
More informationLong-Term Care Community Diversion Pilot Project
Long-Term Care Community Diversion Pilot Project 2010-2011 Legislative Report Rick Scott, Governor Charles T. Corley, Secretary Table of Contents Executive Summary 1 Chart 1 Comparative Cost Trends, FY2006
More informationIllinois Medicaid. updated August 2016 AgeOptions All rights reserved.
Illinois Medicaid updated August 2016 AgeOptions 2016. All rights reserved. 1 What We Will Cover Today What is Medicaid? Medicaid Eligibility Categories of Medicaid Coverage Medicaid Waiver Programs Medicare
More informationMedicaid Overview. Home and Community Based Services Conference
Centers for Medicare & Medicaid Services Medicaid Overview Home and Community Based Services Conference September 11, 2012 1 Overview of Presentation Basic facts about the Medicaid State Plan/program requirements
More informationIllinois Governor s Office of Health Innovation and Transformation
1 Illinois Governor s Office of Health Innovation and Transformation Medicaid Managed Care Conference October 21, 2014 Michael Gelder, Senior Health Policy Advisor to Governor Pat Quinn Executive Director,
More informationThe Way Forward. Towards Recovery: The Mental Health and Addictions Action Plan for Newfoundland and Labrador
The Way Forward Towards Recovery: The Mental Health and Addictions Action Plan for Newfoundland and Labrador 2 Table of Contents Introduction... 2 Background... 3 Vision and Values... 5 Governance... 6
More informationMedicaid Primer. Legislative Service Commission
Medicaid Primer Legislative Service Commission www.lsc.ohio.gov March 2017 TABLE OF CONTENTS OVERVIEW... 1 Medicaid and the Ohio budget... 1 Federal financial participation... 2 FEDERAL OVERSIGHT... 5
More informationILLINOIS 1115 WAIVER BRIEF
ILLINOIS 1115 WAIVER BRIEF STATE TESTING FOR THE FOLLOWING ACHIEVED RESULTS: 1. Increased rates of identification, initiation, and engagement in treatment 2. Increased adherence to and retention in treatment
More informationNew Federal Regulations for Home and Community-Based Services Program: Offers Greater Autonomy, Choice, and Independence
New Federal Regulations for Home and Community-Based Services Program: Offers Greater Autonomy, Choice, and Independence The Centers for Medicare and Medicaid Services (CMS) has published a Final Rule
More informationPreventive Health Guidelines
Preventive Health Guidelines Section N-1 Overview The objective of Molina Healthcare of New Mexico, Inc. (Molina Healthcare) is the delivery of a core package of clinical preventive health services that
More informationA New Multi-County Area Authority Merging The Durham Center and Wake LME
Information on how to continue accessing I/DD Services with the Merger and 1915 B/C Waiver Individuals without CAP IDD Waiver in Johnston County August, 2012 Why are we changing? House Bill 916 is a mandate
More informationAre physicians ready for macra/qpp?
Are physicians ready for macra/qpp? Results from a KPMG-AMA Survey kpmg.com ama-assn.org Contents Summary Executive Summary 2 Background and Survey Objectives 5 What is MACRA? 5 AMA and KPMG collaboration
More informationRural Health Clinics
Rural Health Clinics * An Issue Paper of the National Rural Health Association originally issued in February 1997 This paper summarizes the history of the development and current status of Rural Health
More informationt-:-=:=.=contactd~:i~~~j ~~:~~ ~~~~~Care ====== =-=:=== --. :_=:=:== =-===: :j
Department of State Division of Publications 312 Rosa L. Parks, 8th Floor SnodgrassffN Tower Nashville, TN 37243 Phone: 615-7 41-2650 Email: publications. information@tn.gov For Department of State Use
More informationLouisiana Medicaid Update
Louisiana Medicaid Update HFMA Region 9 Conference November 15, 2015 Origins of Medicaid Means tested entitlement program Established 1965 by Title XIX of the Social Security Act Public health coverage
More informationWHITE PAPER. Taking Meaningful Use to the Next Level: What You Need to Know about the MACRA Advancing Care Information Component
Taking Meaningful Use to the Next Level: What You Need to Know Table of Contents Introduction 1 1. ACI Versus Meaningful Use 2 EHR Certification 2 Reporting Periods 2 Reporting Methods 3 Group Reporting
More informationMedicaid 101: The Basics for Homeless Advocates
Medicaid 101: The Basics for Homeless Advocates July 29, 2014 The Source for Housing Solutions Peggy Bailey CSH Senior Policy Advisor Getting Started Things to Remember: Medicaid Agency 1. Medicaid is
More informationTHIS INFORMATION IS NOT LEGAL ADVICE
Medicaid Medicaid is a federal/state program that gives certain groups of people a card that can be used to get free medical care, nursing home care, and prescription drugs at reduced prices. In general,
More informationNorth Country Community Mental Health Response to MDCH Request for Information Medicare and Medicaid Dual Eligible Project September 2011
North Country Community Mental Health Response to MDCH Request for Information Medicare and Medicaid Dual Eligible Project September 2011 1. What is working well in the current system of services and supports
More informationMedicaid and Block Grant Financing Compared
P O L I C Y kaiser commission on medicaid a n d t h e uninsured January 2004 B R I E F Medicaid and Block Grant Financing Compared State and federal budget pressures, rising health care costs, and new
More informationCentral Ohio Primary Care (COPC) Spotlight on Innovation
Central Ohio Primary Care (COPC) Spotlight on Innovation BY BETTER MEDICARE ALLIANCE MARCH 2017 Central Ohio Primary Care Spotlight on Innovation 1 Central Ohio Primary Care (COPC) Spotlight on Innovation
More informationDEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Chapter 5: Community Care for the Elderly Program CHAPTER 5
CHAPTER 5 Administration of the Community Care for the Elderly (CCE) Program July 2011 5-1 Table of Contents TABLE OF CONTENTS Section: Topic Page I. Purpose of the CCE Program 5-3 II. Legal Basis and
More informationENROLLED ACT NO. 82, SENATE SIXTY-SECOND LEGISLATURE OF THE STATE OF WYOMING 2013 GENERAL SESSION
ENGROSSED AN ACT relating to the Medicaid program; providing direction to the department of health for the reform and redesign of the program; requiring reports; repealing a cap on the number of participants
More informationIllinois Medicaid is Changing - What Case Managers & HIV Providers Need to Know
Illinois Medicaid is Changing - What Case Managers & HIV Providers Need to Know March 29, 2013 Ann Fisher, AIDS Legal Council of Chicago John Peller, AIDS Foundation of Chicago Download the slides & materials
More informationHistory of Medicaid shows the program s value in combating poverty and providing access to health
History of Medicaid shows the program s value in combating poverty and providing access to health ISSUE BRIEF Feb. 3, 2012 Elisabeth Arenales Health care director 789 Sherman St. Suite 300 Denver, CO 80203
More informationFostering Quality Improvement in the SC Medicaid Program
Fostering Quality Improvement in the SC Medicaid Program Medicaid Matching Expenditures as a Percent of Total State General Fund Revenue Medicaid is approximately 1/5 2015 2010 2005 2000 1995 $0 $2,000,000,
More information3.4.2 Scope This applies to all AHCCCS eligible members and Non-Title XIX/XXI eligible persons determined to have a Serious Mental Illness (SMI).
Section 3.4 Copayments 3.4.1 Introduction 3.4.2 Scope 3.4.3 Definitions 3.4.4 Objectives 3.4.5 Procedures 3.4.5-A. Collecting Copayments 3.4.6-B. Copayments 3.4.5-C. Member Copay Matrix 3.4.5-D. Other
More informationMichigan Council for Maternal and Child Health 2018 Policy Agenda
Michigan Council for Maternal and Child Health 2018 Policy Agenda MCMCH Purpose! MCMCH s purpose is to advocate for public policy that will improve maternal and child health and optimal development outcomes
More informationMedicaid Home and Community Based Services Waivers
Medicaid Home and Community Based Services Waivers AN INTRODUCTION TO THE WORLD OF MEDICAID HOME AND COMMUNITY- BASED SERVICES AS OF MAY, 2017*** ***subject to change NASDDDS National Association of State
More informationMedicaid Expansion + Reform: Impact for Trust Beneficiaries. March 8, 2018
Medicaid Expansion + Reform: Impact for Trust Beneficiaries March 8, 2018 Contents 1. Introduction... 3 Medicaid Expansion... 3 Medicaid Redesign... 6 Trust s Role in Medicaid Expansion and Redesign...
More informationHITECH Act, EHR Adoption, Meaningful Use Criteria, ARRA Grants, and Adoption Alternatives. The MARYLAND HEALTH CARE COMMISSION
HITECH Act, EHR Adoption, Meaningful Use Criteria, ARRA Grants, and Adoption Alternatives The MARYLAND HEALTH CARE COMMISSION On February 17, 2009, President Barack Obama signed the American Recovery
More informationSunflower Health Plan
Key Components for Successful LTSS Integration: Case Studies of Ten Exemplar Programs Sunflower Health Plan Jennifer Windh September 2016 Long- term services and supports (LTSS) integration is the integration
More informationManaged Care: We Cannot Stop the Winds of Change, but We can Direct the Sails
1 Information for Managed Care: We Cannot Stop the Winds of Change, but We can Direct the Sails Oklahoma Developmental Disabilities Services October 1, 2015 Barbara Brent, Director of State Policy on behalf
More information